Attachment A – Proposal Form

Please complete Attachment A in its entirety and attach a cover letter signed by your Tribal Leader or organization officer. The completed Attachment A will serve as your proposal response.

PROJECT INFORMATION

Tribe or Tribal-Serving Organization Submitting Proposal:
Enter project name:
Contact Information
Primary Point of Contact:
Title:
Address:
Telephone Number:
Fax Number:
Email Address:
Alternative Point of Contact:
Title:
Address:
Telephone Number:
Fax Number:
Email Address:
Finance/Accounting Point of Contact:
Title:
Address:
Telephone Number:
Fax Number:
Email Address:
5 POINTS: SHARED INTEREST
Please describe the supplemental financial support or in-kind donation that your Nation, Tribe, Pueblo or tribal-serving organization will provide to the proposed project.
10 POINTS: UNDERSTANDING OF PROJECT AUDIENCE
Geographic location of primary population being served:
Targeted area of interest:
Describe the current issues impacting this community, citing data if available:
If applicable, describe community response to or involvement in existing or proposed project:
30 POINTS: PROJECT PLAN
Identify the goals and objectives of this project:
Explain how your project will meet these goals. For example, what specific tasks will be completed to reach these goals and objectives? This section should present a clear roadmap of what you plan to accomplish and how you will accomplish it.
Explain the vision of the project in regards to the sustainability of the project for the next couple of years:
15 POINTS: COSTS
Attach a detailed budget with itemized cost and justification for each cost. For each line item, explain its purpose and specify in detail a timeline of expenditures.
Please reference the list below for ineligible costs that shall NOT be reimbursed under this grant. Also, reference guidelines on mileage and lodging below.
Ineligible Cost Items
  • Indirect cost rate exceeding 20%
  • Food and Beverage
  • Gift Cards
  • Prizes and Incentives
  • Promotional Items
  • Cash
  • Stipends
  • Assets valued at over $5,000
  • Capital expenditures that will not depreciate within one year
Mileage and Lodging
The grant will reimburse for mileage traveled. Mileage is reimbursed at 80% of the internal revenue service standard mileage rate set January 1 of the previous year for each mile traveled. Currently, the State mileage reimbursement rate is $0.46/mile.
Lodging is an eligible expense if the proposer can demonstrate that overnight lodging is required. Lodging guidelines are outlined in the State of New Mexico Travel and Per Diem Regulations (Title 2, Chapter 42, Part 2). You can review these regulations here:
20 POINTS: PERFORMANCE MEASURES
Define in detail the performance measures specific to the project in the following table:
Project Action Items / Duration or Frequency / Completion Date
10 POINTS: PROJECT BACKGROUND
Explain background information on your project providingnumber of years your project has been in existence. Include discussion on achievement of deliverables, project requirements and utilization of funding. Were any funds reverted back to the funding agency? Were any deliverables unmet?
Provide a reference for past experience including phone number, so the Department may verify quality of performance. Do not include a reference from the Indian Affairs Department.
Name:
Organization or Agency:
Phone Number:
Email:
Nature of Project or Service:
5 POINTS: LEADERSHIP ENDORSEMENT
Five points will be awarded for proposals containing the endorsement of a tribal leader or organizational officer.
5 POINTS: GENERAL PROPOSAL
Five points may be awarded for presentation and format of proposal.

OTHER INFORMATION

Use this space to provide any additional comments or information to the evaluation committee. A response in this section is not required, but may be utilized if applicant wishes to include additional information.